Methods for the Study
This essay would highlight on the summarization of the topic interventions for improving the coverage of childhood immunization in low and middle income countries. The main objective that is being used to evaluate the effectiveness of the intervention strategies that is required to boost the sustainability of the high childhood immunization and increase in the survival of children. The immunization health care strategy is made to provide the health services regarding the greater healthy life of the children and increase in immunization coverage of LMICs (Andersson et al, 2009).
The rationale that the paper approaches is the improvement of the public health strategies in the immunization program in the lower and middle income countries. The problems often associated with the low and middle income countries are that the series of vaccines not received properly. This article thus means to address the interventions that are taken to improve the immunization set that is to be given to the child (Banerjee et al, 2010). This is going to evaluate the entire search in the intervention strategies in order to properly administer the immunization coverage in the childhood. This is going to be type of survey program that would be made with the low and middle income countries were there is still occurrence of diseases and that could have been prevented by vaccines. The another reason for choosing this program is to see if the governments are adopting the strategies to increase the vaccination among children (Barham, 2005).
The lack of proper coverage of the vaccination in the developing countries. The population targeted for the study is the children aged 5 years and are receiving the Who recommended vaccines
Search methods including the Cochrane Central Register of Controlled Trials and the selection criteria using randomized control trials and conducted in LMIC involving the children aged from birth (Bolam et al, 1998). The data collection would be done independently screening the search output and reviewing the full texts from eligible literatures. There would be conduction of random effects through meta analysis to assess the certainty of evidence (Brugha & Kevany, 1996). Health education in the community. The key interventions are communication with recipients, trained providers, supervision in health system, policy makers.
Fourteen studies were made in countries like Georgia, Ghana, Honduras, India, Mali, Mexico, Nicaragua, Nepal, Pakistan, Zimbabwe. The community based educations in which the studies from all the above countries would be compared. There were risks of bias while comparing the studies. There was standard care comparison (Dicko et al 2011).
Outcome of interest
Such data collection when evaluated would help to identify the vaccination strategies used by the developing countries. This would also help in coverage of the vaccination for the children. The primary outcome was the proportion of children who received DTP3 in one year of age and the proportion of children that was found of receiving the vaccines. The secondary outcomes were the proportion of children that had received the vaccines. The number of children that have been immunized, costs of interventions, adverse effects and attitude of caregivers (Djibut et al, 2009).
The EPOC risk of bias criteria for randomised controlled trials (RCTs), non-randomised controlled trials (NRCT), and interrupted time series (ITS) studies were in application for the determination of the risk of bias of all eligible studies. The risk of bias were related to selection (allocation concealment) and attrition (incomplete outcome data), blinding of participants, personnel and outcome assessments. These included random sequence generation, selective reporting, similarity in baseline outcome measurements, similarity in baseline characteristics and adequate protection against contamination.
As included in the fourteen studies conducted by the 10 cluster RCT and 4 RCT there were several inclusion biases. The studies were conducted in the middle and low-income countries like Georgia, Ghana, Honduras, India, Mali, Mexico, Nicaragua, Nepal, Pakistan, and Zimbabwe. One study has shown bias which is unclear and 13 had the high risk of bias. The interventions that would evaluate the community-based studies indicated the bias in the three studies. The moderate-certainty evidence in health education in the bias reflected the evidence of the vaccination program of diphtheria. The bias was further analyzed by using the confidence intervals. The immunization coverage idea can be identified with the bias created in the studies. Thus the key criteria for analyzing the bias are that it will identify the immunization strategies adopted by the countries (Maluccio & Flores, 2005).
The data was community-based health education and was mainly done for improving the childhood immunization coverage. There was a table shown in the paper about the results obtained from the 2 studies done in Pakistan. This was a standard core comparison. The outcomes were DTP3 that followed up for 4-9 months. The standard care was 577 per 1000 (Usman et al,2009). The health education was done for 969 per 1000. The effect in the health education group studied with 95% CI and it was based on the assumed risk in the standard care group and the relative effect of the interventions with 95% CI. The whole result was informed by using the 3 doses of diphtheria vaccines. The certainty in vaccination evidence is moderate (Morris et al, 2004). This indicates the likely effect that will be substantially different. This was further rated down on the 1 level. In the summary findings 2, in which a facility based health education was designed for improving the childhood vaccination. In this study, the children population of age 6 weeks was taken for study. The setting was done in Pakistan. The intervention followed the facility based health education and redesigning the reminder vaccination card (Owais et al, 2011). The certainty of evidence was low. The research could not follow the reliable indication of the likely effect. There could be likely chance of the substantial different case. The result for summary 3 indicates the setting at Nicaragua (1 study) and Zimbabwe (1 study). The number of participants was 1000. However, the chances in the certainty were very low. The entire study prepared in the summary 3 was rated down by 2 levels and were judged at high-risk bias (Usman et al, 2011). For the summary setting 4, the children population that was to be surveyed were from 12-18 months and the setting was made in Ghana following the home visit interventions (Robertson et al, 2015). Again the results came out to be, research that provides the indication which could have likely less chance of affect. The entire study of the data was reported with the electronic and supplementary and electronic searches. Thus the main findings indicate the moderate certainty evidence of vaccination with the three doses of diphtheria. Low certainty e4vidence that facility based health education and is also redesigned vaccination cards that may improve DTP3 coverage. Regular immunization outreach is going to make an improvement in the coverage of vaccination. Household monetary incentives may have improvement of full immunization coverage. The confidence interval exhibits the evidence of low certainty. Home visits to identify the non-vaccinated children and was refer them to health clinics and would improve the uptake of three doses of oral polio vaccine. In the integration, there was low certainty evidence and other services that improve the DTP3 coverage.
Main Findings in the Review
Experts in this paper have highlighted the wide range of interventions. There are several settings that showed different affects in an uptake of vaccines. The issues vary due to social, economic, cultural geographical political and religious factors. The potential interventions depend upon all the different settings. Broadly, the strategies would include the interventions that are recipient-oriented, reminders, health education of clients, recipient recalls, reminders, provider oriented interventions (Pandey et al, 2007). The main types of interventions that were considered here were the recipient-oriented interventions, for example, the interventions to improve the communication for the immunization strategies in childhood. The health education is on the importance of the completion of the schedule made for immunization. It would also give the health education on the ‘reminder type’ immunization that would remind the care givers for the next appointment. There was easy understanding through the pictorial card using language that would explain how the techniques and the time of using the immunization and the center location of the children’s life. In order to increase the demand for preventive care, interventions are to be taken. In this s action, both conditional and unconditional cash transfers are given to encourage the child development services and increase the health care (Hayford et al, 2014).
The next strategy is the provider-oriented interventions. This was done by training the immunization district managers that would support the supervision, audit, and feedback regarding the solving problems ob immunization services (Hu et al, 2015). The health system oriented interventions were also taken which included the home visit to identify the unimmunized children. The regular outreach session in the villages was done to ensure regular availability of immunization services. There would be an integration of the immunization with intermittent preventive treatment of malaria taken to support child health interventions.
Implications for future research would indicate the effective strategies that should be followed by the middle and low-income countries to increase the coverage for the immunization of the children. This would increase the survival rates of the children. The paper would identify the scenario for the future direction in the interventions like a promotion of the health care concerns on immunization can be taken. Research based further surveys can be made following the study from this paper. The moderate and low certainty findings would give the community-based health education strategies that would be including the policy and decision making in any settings for a research based plan. The interventions that were taken and mentioned in the paper would further help in making the active plan for immunization coverage. Thus the paper would favor the increase in immunization coverage. This would provide the regulations to make vaccination a requirement before the school entry. Such would give the plans in making policies that would increase immunization and help in more of disease reduction. Since the paper gives an evidence based studies, in future this would help in research on the development of new vaccines and its outreach in the populations. Thus the key implications in future research would indicate
- The development of new vaccine in any population based on the evidence study and the settings showed by the paper
- Research for policy development for the improvement in the immunization coverage among the population.
- The interventions in the paper would further implicate for the construction in the research based survey and other evidence after following a new strategy for development of vaccines.
There are lots of gaps indicated in the paper as the paper only concentrated on the region wise interventions. There was no strong research based plan on increasing the coverage of vaccination. The evidence of the health care strategies taken in the middle and low-income countries is only given by certainty. If the certainty is low that means the research done and the practical result could be different. The outreach and the strategies reflected from the paper is totally region dependent. Such strategies need to be modified with the confidence interval for different regions. The study was performed on only diphtheria vaccine in the regions. The other vaccines strategy must also be seen to get the entire coverage idea of the vaccines. Nowadays new vaccines like the recombinant vaccines and D.N.A vaccine implementation should have been studied. The promotional interventions and the checking of the vaccine strategies in the health care should have been observed with the recent research of vaccines. There was no provision for the comparison of a study with a developed country and the developing countries. Such would have been a case control qualitative study that could have provided the good indication in the strategies that are followed and the strategies not followed. There is no suggestion for the improvement in the quality of the health care centers for the correct dose of the vaccines and to see if the recently developed vaccines are being used. There were gaps in the statistical analysis for the comparison in between the 14 countries and the data collected. Such analysis could have given the most realistic view of the outreach vaccination program. The paper did not give any research based study for the improvement in the vaccination uptake and works.
A number of significant gaps can be highlighted from the study that draws attention of researchers. Since the interventions were set up as parallel programs, there arises a doubt regarding the effectiveness of these interventions when integrated with different services within the health system. Common level of resources, as available in health settings, including manpower, might not be adequate in implementing the interventions. Furthermore, there was a limitation of the cost information provided in the studies. It is to b highlighted that with more robust cost effectiveness it becomes imperative that studies are effective. In addition, access to valuable studies undertaken in middle-income and low-income countries were limited and only those available due to indexing were accessed. Lastly, there is not enough evidence that analyze the impact of monetary incentives on immunization uptake. This is also a significant gap in the review study. The gap is noteworthy since challenges and hindrances faced by policy makers while planning incentive interventions are to be properly outlined in a Cochrane systematic review on conditional cash transfers.
Oyo?Ita, A., Nwachukwu, C. E., Oringanje, C., & Meremikwu, M. M. (2012). Cochrane Review: Interventions for improving coverage of child immunization in low?and middle?income countries. Evidence?Based Child Health: A Cochrane Review Journal, 7(3), 959-1012.
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